It all starts with follicle stimulating hormone (FSH) and luteinizing hormone (LH). FHS helps the eggs mature and follicles grow till one is mature enough to be released in ovulation. Luteinizing hormone, on the other hand, is what triggers the release of the egg once it’s ready to go.

In people who don’t have PCOS, the ratio of luteinizing hormone (LH) to follicle stimulating hormone (FSH) is around 1:1. In PCOS, LH to FSH ratio is closer to 3:1. When that happens, follicles try to mature, but then the relatively high level of LH interrupts them in the middle of their growth and they never end up getting big enough to be released.

​PCOS is one of the most common causes of infertility in the US. But don't lose hope! For most people PCOS is totally treatable. Read on to find out more...

So… what treatments do we have for PCOS? ​

First off I just have to say that treating PCOS is complicated and not the type of thing most people can do on their own (unless they have a background in reproductive health or herbal medicine). Even the herbs often require complex cycling and may or may not be safe if you are actively trying to get pregnant. SO… what I’m trying to say is, talk to your naturopath, midwife, holistic OBGYN, or herbalist if you’re interested in the therapies below.

Diet

Because many people with PCOS also have insulin resistance, the goals of a PCOS diet are often focused on regulating blood sugar - aka low carb, high in vegetables and fiber, higher in healthy protein and healthy fats.

A common macronutrient ratio is 20% of calories from carbs to 30% calories from protein and 50% calories from fat, or something close to that (25:25:50, 20:20:60, etc). Remember - those numbers are a percentage of calories, not volume or weight. For example, one ounce of rice has 37 calories, while the exact same amount of coconut oil (by volume) has 245 calories.

The type and quality of these foods matters a lot - we’re talking about healthy carbs, like organic fruit and starchy vegetables, healthy proteins like fish and hormone-free meats, healthy fats such as coconut oil, olive oil, and grass-fed animal fats.

All of that extra care and money that goes into buying clean foods can make a big impact on your body’s overall ability to regulate your hormones. In addition, keeping your liver happy (which is the organ that takes the brunt of the burden to detox all the junk we are exposed to in our environments and food) may help your hormone regulation, as it’s where many of your hormones are broken down so that your body can get rid of them.

Specific Nutrients

Certain nutritional supplements are often recommended for PCOS as well. The following have been shown to be especially helpful:

- Inositol: there are two main forms of inositol: myo-inositol and d-chiro inositol. When you buy inositol in the store, the type is often not specified - which is an issue for certain conditions but not a big deal for PCOS because both forms help increase fertility and regulate hormones. The main difference is how much you have to take (the dose for d-chiro-inositol is around 900-1200mg while the dose for myo-inositol is closer to 4000mg).

Inositol has been shown to reduce testosterone, DHEA-S and LH in people with PCOS, increase ovulation rates and fertilization rates, and may even help prevent certain birth defects. Check out this article for more information on the science of inositol for PCOS.

- In the naturopathic world, we also like to use CoQ10 and Melatonin to reduce oxidative stress. This helps increase the quality of the eggs (which is often reduced in PCOS).

If you are interested in getting any of these supplements from a high-quality supplier (and at a 10% discount!) check out my online medicinary here.

Herbs

PCOS has been successfully regulated by herbal medicine for a very long time.

- Vitex agnus-castus (Chase tree berry): This herb works by regulating the release of LH and FSH in the pituitary. It’s the classic PCOS herb and has been used for infertility and menstrual irregularity for centuries.

- Angelica sinensis (Dong Quai root): This herb helps blood flow to the pelvis and can be useful for people who don’t menstruate regularly (or at all) because of PCOS.​- Serenoa repens (Saw Palmetto berry): This is mainly used to keep the endometrium a healthy thickness. In PCOS the endometrium can become hyperplastic (too thick), which can affect implantation.

Again, these herbs may not be safe in pregnancy or certain specific medical conditions so please seek the guidance of a qualified health care practitioner.

Medications

There are a lot of pharmacological treatments for PCOS - some of them are are geared toward helping people with PCOS regulate their insulin (which is often high), while others, such as oral contraceptives, are geared toward regulating the menstrual cycle. For the sake of this article I’m going to stick to treatments that are focused on trying to help people with PCOS get pregnant.

Because PCOS interrupts or prevents ovulation, all of the standard medications to stimulate ovulation are used to help with PCOS-related infertility. The main medications currently in use for this are:

- Clomid: This is a type of medication called a SERM: a selective estrogen receptor modulator. It works (in a round-about way) by increasing follicle stimulating hormone (FSH). That helps move that 3:1 LH to FSH imbalance closer to a 1:1 balance. That 1:1 ratio is just what’s needed to let one of the follicles to grow to full size and be released.

- Femara (aka letrozole): Femara is an aromatase inhibitor. It’s a different type of medication from Clomid, but it has a similar result: it triggers your body to release more FSH, thus bringing your LH to FSH ratio back into balance.

- FSH hormone injections: This is pretty self-explanatory - just adding some FSH to get that LH:FSH ratio closer to 1:1

...And That's Just a Brief Overview!

Like I said, PCOS is complex, and treatments for PCOS are complex as well. Find yourself an awesome naturopathic doctor, qualified herbalist, or holistic DO/MD who understands how it all fits together if you feel like PCOS is getting in the way of your fertility.

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​This blog is intended for educational purposes only.Information expressed herein does not constitute medical advice and in no way should be used as a substitute for the advice and attention of a qualified medical practitioner.

While many states offer regular medical licensing to naturopathic physicians, Michigan does not currently offer licensure to naturopathic doctors. I am licensed as a Naturopathic Doctor (ND) in the State of Vermont. In Michigan, until our licensing bill is passed, naturopathic medicine is not intended to diagnose, treat, or cure any disease and is not intended as a substitute for regular medical care. Because of this I work locally under the title Naturopathic Health Consultant.